Dysprosody is a disorder of intonation, rhythmic, melodic characteristics of speech production. When prosodic components are violated, speech becomes monotonous, hypophonic, arrhythmic, devoid of emotional coloring and expressiveness. Dysprosody is present in the clinic of dysarthria, rhinolalia, tempo-rhythmic disorders, Parkinson’s disease, foreign accent syndrome. Diagnostic tactics involve neurological, psychological-psychiatric, speech therapy examination. Treatment is carried out with medications, psychotherapeutic, physiotherapeutic means. Additionally, speech therapy is required.
Causes of dysprosody
Foreign accent syndrome
This linguistic phenomenon may have a neurogenic and psychogenic origin. Neurogenic foreign accent syndrome (FAS) occurs in patients who have suffered a stroke or TBI, suffering from multiple sclerosis, brain tumors. Psychogenic disorder is more often associated with schizophrenia, autism, manic-depressive psychosis, hysteria.
Clinical manifestations of dysprosody in these cases are characterized by the appearance of a foreign accent in the patient’s speech. Sounds acquire phonetic features of another dialect. The speech intonation changes, accents in words and logical pauses in sentences are distributed differently. The modulations disappear in the voice, monotony appears. At the same time, there are no problems of articulation, speech as a whole remains understandable, semantically correct and coherent.
Dysarthric disorders are represented by a complex symptom complex, the structure of which includes pronunciation difficulties, phonetic disorders of the voice. Prosodic characteristics of the voice vary to varying degrees in all forms of dysarthria: erased, bulbar and pseudobulbral, extrapyramidal, cerebellar.
Signs of dysprosody in children with dysarthria are noticeable at an early age: vocal reactions are not differentiated, there is no intonational expressiveness of gurgling and babbling. With the development of phrasal speech, prosodic disorders become especially noticeable. The speech of the dysarthric is inexpressive, monotonous, the tempo is slowed down, the rhythm reproduction is disrupted. There are no or insufficiently developed sound modulations, rhinophony is noted, the “fading” of the voice towards the end of the phrase.
For cerebellar dysarthria, speech dysrhythmia is pathognomonic. It is expressed in the chanting of statements, the appearance of unnecessary pauses, the violation of melody, fluctuations in the strength of the voice. There is rhinophony, vocal trembling, defects of ringing and softening – all this makes speech slurred, tense.
The main cause of dysprosody in open rhinolalia are anatomical defects of articulatory organs (cleft palate and upper lip), causing air leakage. The voice loses its sonority, becomes muffled, strangled, weakly modulated with a nasal tinge. It is difficult to change the pitch, control the melodic-intonation means of utterance. Expressiveness and intelligibility of speech suffer.
With the closed form of rhinolalia, pathological changes in the nasal cavity (adenoids, mucosal hypertrophy, curvature of the nasal septum), on the contrary, make it impassable for air flow. In this case, the timbre, pitch and strength of the voice also suffer, but there is a reduced nasal resonance. Typical distortion of nasal phonemes, tone deafness, the appearance of unnatural intonations in the voice.
Violation of the pace of speech
Slowing down or accelerating the pace, speech dysrhythmia change the prosodic characteristics of speech as a whole. Dysprosody is characteristic of the following tempo-rhythmic disorders:
- Bradylalia. There is a stretching of words, an unjustified increase in pauses, chanting of utterance. Dysprosody is facilitated by the fixation of the voice at the same height, the absence of intonational expressiveness and smoothness of utterance.
- Tachylalia. With tachyphrasia, words are pronounced at a fast pace, almost without pauses, as if in one breath. The absence of logical stops, semantic accents, melodic intonations makes speech illegible. Tachylalia can occur with the phenomena of stuttering, dysarthric component.
- Cluttering. The speech tempo is accelerated, but the utterance is constantly interrupted by pauses, inappropriate exclamations, embolism words. The lack of fluency of speech is combined with a change in the strength of the voice: from loud exclamations to quiet muttering.
Dysprosody in stuttering is caused by the disorganization of the tempo-rhythmic pattern of the utterance. Stammerers try to speak quickly in order to have time to finish a phrase between speech spasms. However, another muscle spasm of the articulatory or vocal apparatus interrupts the orderly speech flow – there are convulsive stutters.
The violation of speech fluency is aggravated by improper breathing with uneven use of air. The musicality of speech suffers: there is no control of pausing, harmony of melody, emotional coloring. Dysprosody is also enhanced by the vocal clamps and logophobia that form over time.
In children with motor alalia, all components of expressive utterance are disrupted. The lexical stock is poor, agrammatism is present in large numbers, phrase formation is delayed, gestures or onomatopoeia are used in coherent speech. Dysprosody is manifested by slowness of the speech flow, incorrect placement of logical accents, lack of a sense of rhythm. Monotony, fragmentary, inexpressiveness of speech is noted.
With efferent motor aphasia, “kinetic motor melodies” are upset. The rhythmic structure of the word disintegrates, numerous jams on previous speech fragments (perseverations) are observed. The melodic-intonation side suffers significantly: pronunciation becomes jerky, “ragged”, syllabic, slow. Dysprosody is aggravated by the combination of efferent motor aphasia with dysarthria.
With various vocal disorders (dysphonia, phonasthenia), the phonation becomes whispered, strangled, tense. The voice is deaf, broken, hoarse, quickly fading. Dysprosody is expressed in the loss of melody, intonation expressiveness, emotionality of speech. Voice disorders are also characterized by subjective sensations: pain and sore throat, vocal fatigue, feeling of a lump.
Voice-speech disorders develop in most patients with Parkinson’s disease, often they occur already at the onset of the disease. Gradually the voice changes: hoarseness, hoarseness, trembling, hypophony appears. Articulation difficulties arise.
Dysprosody joins – speech slows down, becomes muffled, poorly modulated, loses its smoothness and emotional coloring. Palilalia (autoecholalia) are typical. Similar speech disorders that occur in PD are regarded in speech therapy as hypokinetic dysarthria. Similar changes are characteristic of secondary Parkinsonism.
Dysprosody in hearing loss has a persistent and pronounced character. Due to the lack of full-fledged auditory control, it is difficult for hearing-impaired patients to both perceive and reproduce intonation, change the pitch and strength of the voice. Their voice sounds dull, monotonous, expressionless. It is difficult to pronounce interrogative and motivational statements. The pronouncing side of speech is characterized by deafening of sonorous sounds, multiple substitutions and mixing of sounds, violation of the syllabic scheme of the word.
Much less often dysprosody can be etiologically associated with the following conditions:
- epilepsy with gelastic seizures;
- Huntington ‘s chorea;
The assessment of the state of prosodic components of speech is carried out by a speech therapist, the identification of the underlying pathology is carried out by narrow medical specialists: a neurologist, an otorhinolaryngologist, a psychiatrist. Examination of a patient with dysprosody includes the following diagnostic blocks:
- Neurological diagnostics. Neuroimaging is necessary to detect organic changes in cerebral structures. MRI of the brain, Echo-EG, PET-CT are performed. In order to determine the electrical activity of neurons and neuromuscular transmission, electroencephalography and electroneuromyography are performed.
- Examination of ENT organs. It is indicated for the detection of hearing disorders, changes in the vocal folds, obstruction of the nasal cavity, palatine clefts as causes of dysprosody. Endoscopic examinations include videolaryngostroboscopy, otoscopy, and nasal endoscopy. To assess the function of the ENT organs, audiograms, electroglottography, and electromyography of the larynx are recorded.
- Psychodiagnostics. It is aimed at studying the mental activity of the patient, differential diagnosis of pathopsychological syndromes. Special questionnaires, tests, scales are used, conversations, observation, experiments are conducted.
- The study of oral speech. Speech therapy examination in dysprosody involves the analysis of various components that make up the prosodic organization of speech. The perception and reproduction of rhythm, intonation, voice modulations, logical accents, speech tempo, etc. are studied. Age-appropriate speech material is selected for the examination. With individual nosologies, sound pronunciation, phonemic processes, possession of lexical and grammatical categories are investigated.
Correction of dysprosody consists of medical and speech rehabilitation. The specific content and duration of each stage is determined by the underlying disease. In most cases, the therapeutic course includes the following general directions:
- Pharmacotherapy. It is the main method of therapy of acute and chronic pathologies of the central nervous system, mental diseases. Drug treatment is prescribed to minimize damage to cerebral structures, slow down the progressive course of pathological processes, and create favorable conditions for recovery work. Taking into account the main nosology, it may include taking nootropics, anticonvulsants, dopaminergic drugs, antidepressants, neuroleptics, etc.
- Psychotherapy. It is required if patients with dysprosody have depression, secondary mental layers, behavioral disorders. The treatment courses include cognitive behavioral therapy, relaxation training, auto-trainings, and game therapy.
- Physical therapy. Normalization of innervation and muscle tone is promoted by massage (general, NCZ), acupuncture. Electrophoresis, electrostimulation of speech muscles, magnetotherapy, amplipulstherapy, etc. have a beneficial effect on the central and peripheral organs of speech.
In some cases, surgical care is required to eliminate the organic basis of dysprosody: cheiloplasty and uranoplasty (for facial cleftages), adenotomy and polypotomy (for nasopharyngeal growths). In case of hearing loss, hearing replacement is indicated.
The plan of speech therapy classes in dysprosody is compiled after the identification of the leading speech defect and its structure. The work on normalization of prosodic components is carried out in stages:
- Preparatory activities: development of speech breathing (respiratory gymnastics), activation of articulatory motor skills (articulatory gymnastics, speech therapy massage, electrostimulation VocaStim), development of phonational kinesthesia (vocal and orthophonic exercises).
- Correction of dysprosody: reproduction of rhythm, intonation, stress, voice changes in strength and height;
- Automation of skills: performing training exercises based on didactic material, consolidating skills in free speech.